Coding And Reimbursement Specialist Jobs in Springfield, IL

The Revenue Cycle Coding & Auditing Manager provides strategic and day-to-day leadership over coding, coding education and billing compliance/auditing. This role ensures that all billable services are coded timely, accurately, and compliantly; oversees internal and external audit activities; assists with the development of coding/billing education; oversees the function of providing education; optimizes workflows and technology; and partners closely with Clinical Operations, Revenue Cycle and IT to enhance reimbursement, reduce denials, and safeguard compliance with federal/state regulations and payer policies.

Job Relationships

Reports to the Director of Revenue Integrity 

Principal Responsibilities

• Lead, develop, and evaluate coding and auditing staff; set performance goals and foster accountability, equity, and continuous improvement. 
• Oversee daily workflows, work queues, and staffing to meet productivity, quality, and SLA standards. 
• Manage budgets and forecast staffing/resources to support volume, accuracy, and compliance needs. 
• Standardize policies, procedures, and controls to ensure consistent, efficient, and compliant operations. 
• Institute and oversee internal and external coder audits; ensuring a high degree of quality and accuracy of coding
• Ensure timely, accurate, and compliant ICD-10-CM/PCS and CPT/HCPCS coding and charge capture. 
• Partner with providers to improve documentation, medical necessity support, and coding accuracy. 
• Oversee coding, billing, and documentation audits, including audit plans, sampling, scoring, and corrective actions. 
• Monitor and optimize claim editing and encoding systems; analyze coding denial and coding edit trends and implement sustainable fixes. 
• Establish monitoring systems to ensure adherence to Medicare/Medicaid regulations, payer policies, and organizational standards. 
• Develop and deliver coding and billing education for clinical and non-clinical staff, including new provider onboarding. 
• Publish guidance and tools that translate regulations into clear, operational workflows. 
• Analyze coding and medical necessity denials; lead root-cause analysis and implement prevention strategies. 
• Collaborate with revenue cycle teams to improve first-pass yield, reduce rework, and compliantly enhance reimbursement. 
• Recommend and implement process and technology improvements to boost clean-claim rates and reduce A/R days. 
• Monitor KPIs, conduct trend analyses, and present performance and risk updates to leadership. 
• Serve as a subject matter expert on coding, compliance, and revenue cycle best practices; stay current on regulatory changes. 
• Lead continuous improvement initiatives to streamline workflows and improve the provider/patient and employee experience. 
• Ensure timely, professional responses to provider, patient, and payer inquiries related to coding and reimbursement. 
• Adhere to organizational policies, compliance standards, and safety requirements. 
• Perform other duties as needed to support departmental and organizational goals.

Education/Experience

• Bachelor of Science in Health Information Management degree or equivalent required, master's degree in business or finance related field preferred. 

Licenses/Certificates

• CPC (Certified Professional Coder) Certification required within 1 year of hire.
• CCS-P (Certified Coding Specialist-Physician based) Certification required within 2 years of hire.
• RHIA (Registered Health Information Administrator) Certification required.

Knowledge, Skills and Abilities

• Excellent verbal and written communication; conflict and problem resolution skills
• Excellent strategic, analytical and process systems thinking skills 
• Demonstrated expertise with Teams, Excel, Visio, PowerPoint and other Microsoft Office products 
• Excellent interpersonal skills, including ability to understand and articulate the needs of stakeholders and assist them in making the decisions necessary to accomplish their objectives
• Demonstrated ability in earning and maintaining credibility with leaders across the organization 
• Ability to respectfully and collaboratively challenge team members to perform within designated timelines 

Working Environment

• Requires sitting and standing for periods of time working in an office environment.
• Use of telephone required.
• Some bending and stretching required.

PHI/Privacy Level

HIPAA1